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Help!! Baby not gaining enough at 6 mo check

I'm devastated. I returned to work October 23rd and thought all was going well until today. Today was his 6 mo check up and he has only gained a little over a pound since the last visit. He weighs 13 lbs 5.5 oz and is in the 1st percentile =( He was always a peanut, but weight gain has decreased since the previous visits. Dr. was never concerned until today and so am I. I nurse LO in the morning before leaving for work, around 6:15. Sometimes I nurse him twice if he wakes earlier and then wake him before leaving to nurse a second time. I am away from baby 6:45-3:30 and I pump 3 x while at work (which is the most I can pump). The first time I pump btw 3-5 oz, depending on the day and then only 2-3 oz total the last two times. I usually pump before bed too in order to pump what he ate. He usually takes 3- 3oz bottles and care providers (daycare and my dh) say that he seems usually satisfied (occasionally wants an extra oz). I give an extra bottle daily just in case. I don't know what to do. We've introduced solids, but he's not that interested and I know that doesn't add much calories. Dr. recommends more solids and possibly considering suplementing after nursing, but I worry this will only decrease my supply and make it so that he will get less and less from me (eventually causing early weaning). My goal has always been at least 1 year, but most importantly I want my LO to gain what he should. I am SO sad right now!! I feel defeated. This has been hard enough going back to work and I feel like this is now sabatoging our nursing relationship. I already only get like 4-5 hrs of sleep because of how early I have to wake to feed him and get ready. I have been using a stupid nipple shield this entire 6 months because at first had trouble with staying latched, and now he's just used to it. Could this be affecting my supply? We didn't think so (met w/ lactation consultant and seemed to be going well w/ shield) but now I don't know what to think. I don't pump much, but then again I have the smallest flanges and could go down a size because of the small size of my nipples. There are so many factors and bottom line, I just want this to work and to be best for my son. I just want to cry! Any advice/ help would be greatly appreciated. I do have a large stash of bm stored in the freezer if I do need to supplement (before turning to formula)- but again I fear that this will be a slippery slope towards early weaning. Sorry for the long message- your help is so greatly appreciated.
Sincerely,
Mama in tears...

First-time mom to David Alan, born 5-20-12. Enjoying maternity leave for his 1st 5 months and then returning to full-time work as a school social worker and nursing mom.

Re: Help!! Baby not gaining enough at 6 mo check

Are you nursing at night also, or just during the day? I would think that you could increase the number of feedings, rather than the total oz at each feeding. Your feeding pattern sounds like mine, as far as it goes... morning nurse, 3 3-oz bottles while I'm gone. Then we nurse as soon as I get home, I nurse DS to sleep at bedtime, and he nurses several times at night. It does cut into my sleep but it makes me feel a lot better about not being able to pump very much (in terms of oz... in terms of time I'm also pumping 4 times a day, bleh).

Should we increase bottle size (I have stored up breast milk)? Add extra bottles? Supplement? Or just increas solids to 3 servings a day? Will this be enough? Up until last appt only experimented w/ oat cereal and bananas, but not receiving daily solids. Dr recommends 3 servings daily if solids and we have a weight check scheduled for 1-14-12 (6 wks from 6 mo check). I'll do whatever I need to get his weight back on track. So scared working is sabotaging our nursing relationship. Been pumping 4x daily (3 at work, 1 x at night before bed) to get the 9 oz he's been taking. Should we tryto get him to take larger bottles? Your help is GREATLY appreciated.

Oh and he sleeps through the night (no Feedings) but will wake at 4:30 usually, then I feed 2x before leaving at 7

First-time mom to David Alan, born 5-20-12. Enjoying maternity leave for his 1st 5 months and then returning to full-time work as a school social worker and nursing mom.

Re: Help!! Baby not gaining enough at 6 mo check

Did I understand correctly that you're still using a nipple shield? That can decrease milk transfer. When did you last meet with the lactation consultant? Another visit may be in order to re-address the shield and whether/how you can do away with it. Increasing solids is NOT the way to go - more breastmilk is what he needs. A 6 month-old is just not developmentally ready to get enough calories in him from solids; up to a year breastmilk is baby's primary source of nutrition. Adding a nighttime feeding would help if baby is STTN.

Re: Help!! Baby not gaining enough at 6 mo check

Really considering weaning and transitioning to formula, but the thought makes me so sad. My LO just doesn't seem that interested in nursing anymore and is too impatient to wait for more than 1 let down, except before bed when he is sleepy. Also, Feedings are so much shorter in duration because he's so distracted, even wheni feed him in a dark room. With our weigh gain concerns, I just don't know if it's worth the struggle anymore. I have been off all week for Christmas brak and was hoping that this would boost to our nursing relationship, but it's been such a struggle to get him to eat- I feel like he'd rather have the bottle! If he was gaining great, I wouldn't be so worried/ discouraged, but I'm so close to just giving up. I REALLY need some encouragement mamas!

First-time mom to David Alan, born 5-20-12. Enjoying maternity leave for his 1st 5 months and then returning to full-time work as a school social worker and nursing mom.

Re: Help!! Baby not gaining enough at 6 mo check

So sorry, mama, I know this wasn't the Xmas present you were hoping for.

I don't think you should wean, because the idea makes you sad and because it's not like formula is a magic fix for weight issues. Beastmilk generally has slightly more calories per oz than formula, and of course it haas immunologic benefits that formula can't provide. So the milk you're pumping at work- that's valuable stuff! Especially for a baby who is in daycare and is exposed to all sorts of nasty germs. You might need to supplement with formula if you're having trouble meeting your baby's needs or if he's unwilling to nurse enough to maintain a full supply- but that's very different from total weaning.

Can you walk us through his daily schedule at this point? How many times does he nurse, how many bottles does he get per day, is he still getting 9 oz while you're at work?

Re: Help!! Baby not gaining enough at 6 mo check

His schedule varies day to day, but I can try to give you the average day when I'm at home and at work. During the work week, I wake him at 4 am to feed if he hasn't woken on his own (will generally sttn from 8-4 or sometimes even 6), and then again at 6:15 to feed before I leave. I pump 3 times at work and one at night when he goes to bed and I pump anywhere from 9-11 oz total. I feed him immediately when we get home, around 3:45 and then again around 5, 6:30 and then before bed at 7:30 (he's usually asleep by 8). He takes 3 3 oz bottles at dc and both dc and husband say its sometimes hard to get him to eat that much. We've also added to solid meals during the day (at the advice of pediatrician). So he eats 9 x when I work, plus 2 meals. When home, I feed on demand, anywhere from 8-12 times, but 9 is pretty typical. No bottles when I'm home. he eats every 1-3 hrs, but usually every 1 1/2-2, except when napping. Naps are variable, as he's more of a cat mapper and good night sleeper.

I wouldn't even know where to start w/ formula as supplement because he doesn't act like he wants to eat more and I'd be afraid It would decrease supply more. So at a loss...

Last edited by @llli*davidsmomma; December 28th, 2012 at 08:03 PM.

First-time mom to David Alan, born 5-20-12. Enjoying maternity leave for his 1st 5 months and then returning to full-time work as a school social worker and nursing mom.

Re: Help!! Baby not gaining enough at 6 mo check

Thanks for the detailed response. Nothing really leaps out at me as being "wrong"- you're feeding him frequently and in what sounds like adequate amounts. I was sort of wondering if you'd say that he only nurses 5 or 6 times a day or something like that- then it would be obvious that the solution would be to feed him more often.

The one thing that I do notice that could be problematic is that he's a "good" sleeper. Those long stretches of sleep must be a godsend for a working mom- heck, for any mom!- but if your goal is to get more calories into him, I'd wake him to nurse at least once, maybe right before you go to bed. Babies can take in a lot of calories during nighttime feedings.

Another thing you could try would be to offer him "double cream" bottles. You pump a bottle, allow it to sit and settle, and then pour off the fatty layer into another bottle, and, voila! It's a bottle with 2x the fat, and you feed that bottle to the baby. This is going to mean pumping more than you currently are, to get that extra bottle- but if you can stand to do it, then why not try it?

Some things to check with the doc- your LO's iron status (anemia can cause issues with growth) and also the possibility of reflux. Some babies are reluctant eaters because using their digestive systems hurts, and sometimes these babies aren't big spitter-uppers. There are babies who have so-called "silent" reflux, where the stomach contents come up but are reswallowed insteadof being spat out.